Preparation

1. Prior to stent placement, the patient undergoes barium contrast esophagography to determine the location and extent of the tumor and identify any fistula.  There are several considerations that affect the choice of stent.  If a fistula is demonstrated, use of a covered stent is most appropriate.  The length of the stent should be 4-6 cm longer than the esophageal stenosis to reduce the possibility of tumor overgrowth at the ends of the stent.  If multiple stents will be required to cover a long stricture, the most distal stent should be deployed first, and the stents should be overlapped by at least 3 cm to insure adequate stent anchoring.
   
   

2. The procedure is performed using neuroleptic analgesia and topical lidocaine spray for the oropharynx.  A cut-off, small caliber nasogastric tube or angiographic catheter is used in conjunction with a guidewire to traverse the stricture and enter the stomach.  Using the technique described previously under Fluoroscopically Guided Balloon Dilatation, the stricture is dilated with an 8-cm-long balloon to a diameter of 12 mm to 15 mm to facilitate placement of the stent .  If the stricture cannot be dilated to at least 12 mm, stent placement is generally not possible.
   
   

3. Based on the information obtained from the esophagogram and the length of the waist-deformity on the balloon during its inflation in the stricture, anatomic landmarks are fluoroscopically identified inside the patient or radiopaque markers are taped to the patient's skin to demarcate the ends of the tumor.  Using fluoroscopic guidance, the prepackaged delivery system is used to deploy the esophageal stent in accordance with the manufacturer's instructions.